Analysis Of Gynecological Clinical Application In Transvaginal Natural Orifice Transluminal Endoscopic Surgery

[Objective]To study the effectiveness of transvaginal natural orifice transluminal endoscopic surgery on common benign diseases in gynecology[Methods]Retrospective analysis of transvaginal natural orifice transluminal endoscopic surgery(V-NOTES)was performed in the Department of General Gynecology,Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from June 2015 to January 2019.All patients had a total of 30 clinical data.Fully quantified all patient information collected,demographic measurement of age,parity,vaginal delivery history and abdominal surgery history,operation time,estimated blood loss(EBL),hemoglobin drop(Hgb drop)before and after surgery,duration of surgery,postoperative drainage days,postoperative hospital stay(including the day of surgery),postoperative venting and time to get out of bed,12/24 hour postoperative visual analogue scale/score(VAS)and postoperative pathological diagnosis were used to evaluate the outcome of the surgery.According to the types of V-NOTES surgery:salpingo-ophorectomy or oviduct resection,ovarian cystectomy,total hysterectomy and myomectomy evaluate the surgical effect and operability from the perspective of feasibility and practicality.[Results]All patients underwent V-NOTES surgery successfully,without transferred to conventional laparoscopic or laparotomy.One patient developed bladder vaginal fistula after intraoperative bladder injury.The remaining patients had no postoperative morbidity and no intraoperative bleeding.There is no need for blood transfusion treatment and no other organ damage and no other complications.The mean age(±standard deviation)of 30 patients was 50.5(±11.1)years,the median parity(range)was 1(1～4),and the BMI was 24.1(±2.6)kg/m2.Among them,28 cases(93.3%)had a history of vaginal delivery.There were 12 cases of a history of abdominal surgery(40.0%of the total).Thirty patients were classified according to the surgical content,including 6 cases of attachment or oviduct resection(20.0%),2 cases of ovarian cysts(6.7%),1 case of uterine fibroids removal(3.3%)and 20 cases of uterine double attachment resection.(70%);50%of the patients with other surgical operations such as vaginal wall repair,sacrocolpopexy and adhesiolysis.The average operation time was 90.4(±40.1)minutes,EBL52.9(±55.5)ml,and the drop between hemoglobin before and after the operation was 14.6(±7.8,-3～29)g/L.The number of days after indwelling vaginal drainage 1.9(±1.8),the average postoperative hospital stay was 5.0(3.4)days,the postoperative exhaust time was 16.4(±5.9)hours,the postoperative outpatient activity time was 15.2(±6.3),and the postoperative 12-hour VAS score was 3(1-4)points,VAS score 2(0～4)points 24 hours after surgery,total hospitalization expenses 11836.3(±5428.8)yuan.Postoperative pathological diagnosis was cervical lesions,teratoma,ovarian albicans,ovarian simple cyst,ovarian serous cystadenoma,tubal ectopic pregnancy,tubal mesenteric cyst and uterine fibroids.Two cases were found to be cervical squamous cell carcinoma IA2-Ibl(2009FIGO),3 cases of endometrioid carcinoma IA1.In this case,patients with vesico-vaginal fistula were treated with cystoscopy and vaginal hernia repair on the fifth day after surgery.The catheter was preserved for two weeks and recovered.[Conclusion]The results show that the transvaginal NOTES is suitable after the screening of gynecological benign diseases,and it is safe and feasible in the application of salpingo-ophorectomy or oviduct resection,ovarian cyst removal,hysterectomy and fibroid removal.